,i  #aagth ,,congress  #ast ,session    
,h4 ,r4 #cgcc  ,,in ,,the ,,house ,,of  
,,representatives  ,june #d1 #bjba ,ms4 
,tenney 7for herself1 ,mr4 ,larson of   
,connecticut1 ,ms4 ,stefanik1 ,mr4      
,rutherford1 ,ms4 ,herrell1 ,mr4        
,cawthorn1 ,ms4 ,spanberger1 ,mr4 ,budd1
 ,mr4 ,van ,drew1 and ,mr4 ,cohen7      
introduced the following bill2 which was
 referred to the ,committee on ,energy  
and ,commerce1 and in addition to the   
,committee on ,ways and ,means1 for a   
period to be subsequently determined by 
the ,speaker1 in each case for          
consideration of such provisions as fall
 within the jurisdiction of the         
committee concerned  ,a ,,bill  ,to     
amend titles ,,xviii and ,,xix of the   
,social ,security ,act to require       
skilled nursing facilities1 nursing     
facilities1 intermediate care facilities
 for the intellectually disabled1 and   
inpatient rehabilitation facilities to  
permit essential caregivers access      
during any public health emergency under

 the ,medicare and ,medicaid programs4  
#a4 ,short title ,this ,act may be cited
 as the ,essential ,caregivers ,act of  
#bjba4  #b4 ,right to essential         
caregivers ,during a public health      
emergency declared by the ,secretary of 
,health and ,human ,services under      
section #cai of the ,public ,health     
,service ,act1 a resident of any skilled
 nursing facility 7as defined in section
 #ahai7;a7 of the ,social ,security ,act
 7#db ,u4,s4,c4 #acie;i-#c7;a7771       
nursing facility 7as defined in section 
#aiai7;a7 of such ,act 7#db ,u4,s4,c4   
#acifr7a7771 inpatient rehabilitation   
facility described in section           
#ahhf7;a77#a77,z7 of such ,act 7#db     
,u4,s4,c4 #acie;cc7a77#a77,z771 or      
intermediate care facility for the      
intellectually disabled 7as defined in  
section #aije7;d7 of such ,act 7#db     
,u4,s4,c4 #acif;d7d77 has the right to  
designate two essential caregivers to   
have access to and provide assistance   
and support to the resident at any time 

notwithstanding any waiver made under   
section #aace of the ,social ,security  
,act 7#db ,u4,s4,c4 #acbj;b-#e74 ,the   
resident may change who is designated as
 an essential caregiver4  #c4 ,requiring
 facilities to permit essential         
caregivers access during any public     
health emergency  7a7 ,skilled nursing  
facilities2 nursing facilities ,section 
#ahai7;c7 and #aiai7;c7 of the ,social  
,security ,act 7#db ,u4,s4,c4           
#acie;i-#c7;c71 #acifr7c77 are each     
amended-- 7#a7 in paragraph 7#c7--  7,a7
 in subparagraph 7,d71 by striking and  
at the end2  7,b7 in subparagraph 7,e71 
by striking the period and inserting 2  
and2 and  7,c7 by adding at the end the 
following new subparagraph3  7,f7       
implement and maintain1 during any      
public health emergency declared by the 
,secretary under section #cai of the    
,public ,health ,service ,act on or     
after the date of the enactment of this 
subparagraph for the area in which such 
facility is located and notwithstanding 

any waiver made under section #aace1 the
 essential caregivers program described 
in paragraph 7#g74  2 and  7#b7 by      
adding at the end the following new     
paragraph3  7#g7 ,essential caregivers  
program  7,a7 ,in general ,for purposes 
subparagraph 7,f7 of paragraph 7#c71 the
 essential caregivers program described 
in this paragraph is a program          
implemented by a facility described in  
such paragraph under which such facility
 shall--  7i7 allow each resident of    
such facility the unqualified ability to
 elect not more than #b essential       
caregivers 7as defined in subparagraph  
7,d77 to have access to1 and provide    
assistance 7as described in subparagraph
 7,c77i77 to1 such resident at such     
facility1 and allow each such resident  
to amend such election at any time2     
7ii7 permit each such caregiver so      
elected by such resident to provide such
 assistance to such resident at such    
facility for #ab hours every day 7or1 in
 the case such care is end-of-life care1

 for an unlimited number of hours every 
day72 and  7iii7 enforce the agreement  
described in subparagraph 7,c77ii7 with 
respect to an essential caregiver4  7,b7
 ,presumption of election ,for purposes 
of subparagraph 7,a71 in the case of a  
resident who is unable1 by reason of    
physical or mental disability1 to make  
an election described in such           
subparagraph1 the resident              
representative 7as defined in section   
#dhc4e of title #db1 ,code of ,federal  
,regulations7 of such resident shall be 
permitted to make such election for such
 resident4  7,c7 ,essential caregiver   
defined ,for purposes of this paragraph1
 the term essential caregiver means1    
with respect to a resident of a facility
 described in subparagraph 7,a71 an     
individual who-- 7i7 will provide       
assistance consisting of activities of  
daily living1 emotional support1 or     
companionship to such resident2 and     
7ii7 agrees to follow all safety        
protocols established by such facility1 

which shall be clearly specified in     
writing and be the same as such         
protocols 7including safety standards   
and entry requirements7 applicable to   
staff of such facility4  4  7b7         
,intermediate care facilities for the   
intellectually disabled ,section        
#aije7;d7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acif;d7d77 is amended-- 
7#a7 in paragraph 7#b71 by striking and 
at the end2  7#b7 in paragraph 7#c71 by 
striking the period and inserting 2 and2
 and  7#c7 by adding at the end the     
following new paragraph3  7#d7 the      
institution implements and maintains1   
during any public health emergency      
declared by the ,secretary on or after  
the date of the enactment of this       
paragraph under section #cai of the     
,public ,health ,service ,act for the   
area in which such institution is       
located and notwithstanding any waiver  
made under section #aace1 the essential 
caregivers program described in section 
#aiai7;c77#g7 in the same manner as if  

such institution were a nursing         
facility4  4  7c7 ,inpatient            
rehabilitation facilities ,section      
#ahff7;a77#a7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is 
amended-- 7#a7 in subparagraph 7,x71 by 
striking and at the end2  7#b7 in       
subparagraph 7,y71 by striking the      
period at the end and inserting 1 and2  
and  7#c7 by inserting after            
subparagraph 7,y7 the following new     
subparagraph3  7,z7 in the case of an   
inpatient rehabilitation facility that  
is located on the same campus 7as       
defined by the ,secretary7 as a skilled 
nursing facility1 nursing facility 7as  
defined in section #aiai7;a771 or       
intermediate care facility for the      
intellectually disabled 7as described in
 section #aije7;d771 to establish and   
maintain1 during any public health      
emergency declared by the ,secretary on 
or after the date of the enactment of   
this paragraph under section #cai of the
 ,public ,health ,service ,act for the  

area in which such institution is       
located and notwithstanding any waiver  
made under section #aace1 the essential 
caregivers program described in section 
#ahai7;c77#g7 in the same manner as if  
such institution were a skilled nursing 
facility4  4  7d7 ,compliance and       
notification  7#a7 ,authority ,no       
caregiver who meets the definition of an
 essential caregiver in clause 7i7 of   
paragraph 7#g77;,c7 of either section   
#ahai7;c7 and #aiai7;c7 of the ,social  
,security ,act and who upholds the      
agreement described in clause 7ii7 of   
such paragraph shall be denied access to
 the skilled nursing facility 7as       
defined in section #ahai7;a7 of the     
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#c7;a7771 nursing facility 7as  
defined in section #aiai7;a7 of such    
,act 7#db ,u4,s4,c4 #acifr7a7771        
inpatient rehabilitation facility       
described in section #ahhf7;a77#a77,z7  
of such ,act 7#db ,u4,s4,c4             
#acie;cc7a77#a77,z771 or intermediate   

care facility for the intellectually    
disabled 7as defined in section         
#aije7;d7 of such ,act 7#db ,u4,s4,c4   
#acif;d7d77 of the resident involved4   
7#b7 ,notification ,in the event of     
non-compliance with either such clause1 
such facility must first provide a      
warning to the essential caregiver and  
resident in writing citing specific     
issues of non-compliance and providing  
clear guidance for corrective measures4 
7#c7 ,enforcement ,should the essential 
caregiver or resident fail to take      
corrective action1 they may be          
subsequently denied access4 ,in such    
cases1 the facility shall provide to    
such caregiver and such resident 7or    
health care proxy of such resident71 not
 later than #bd hours after such failure
 to allow access occurs1 a written      
explanation as to why such care-giver   
was not permitted to furnish such       
assistance to such resident4 ,such      
explanation must include the resident's 
and caregivers' options for appeal 7as  

described in subsection 7e774  7e7      
,options for ,resident and ,caregiver   
,appeal  7#a7 ,in general ,during any   
period in which any skilled nursing     
facility 7as defined in section         
#ahai7;a7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acie;i-#c7;a7771 nursing
 facility 7as defined in section        
#aiai7;a7 of such ,act 7#db ,u4,s4,c4   
#acifr7a7771 inpatient rehabilitation   
facility described in section           
#ahhf7;a77#a77,z7 of such ,act 7#db     
,u4,s4,c4 #acie;cc7a77#a77,z771 or      
intermediate care facility for the      
intellectually disabled 7as defined in  
section #aije7;d7 of such ,act 7#db     
,u4,s4,c4 #acif;d7d77 is required to    
establish and maintain the essential    
caregivers program under section        
#ahai7;c77#c77;,f7 of such ,act1 section
 #aiai7;c77#c7 of such ,act1 or section 
#aije7;d77#d7 of such ,act 7as added by 
subsections 7a7 and 7b771 the ,secretary
 of ,health and ,human ,services shall1 
not later than #ae days after the first 

day of such period1 establish and       
maintain a process to-- 7,a7 receive    
appeals from residents and caregivers   
challenging a decision to deny access2  
and  7,b7 investigate all such appeals  
within #dh hours of receipt4  7f7       
,enforcement ,with respect to appeals   
received under paragraph 7#a71 the      
,secretary of ,heath and ,human         
,services shall make a determination as 
to whether a facility described in      
subsection 7e77#a7 violated a           
requirement or prohibition in this ,act 
or in an amendment made by this ,act    
within #g days of commencing its        
investigation4 ,if the ,secretary       
determines that a facility has violated 
a requirement or prohibition in this    
,act or in an amendment made by this    
,act1 the ,secretary shall--  7#a7      
require the facility to establish a     
corrective action plan to prevent the   
recurrence of such violation within a   
#g-;day period of receiving notice from 
the ,secretary2 and  7#b7 impose a civil

 money penalty in an amount to be       
determined by the ,secretary if such    
facility fails to implement the         
corrective action plan with the #g-;day 
period specified in paragraph 7#a74  7g7
 ,regulations ,the ,secretary of ,health
 and ,human ,services shall1 after      
consultation with stakeholders          
7including residents1 family members1   
long-term care ombudsmen1 other         
advocates of nursing home residents1 and
 nursing home providers1 promulgate     
regulations to carry out this ,act4